Healthcare Provider Details

I. General information

NPI: 1194895706
Provider Name (Legal Business Name): MATTHEW JAMES MILLET P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST SUITE 100
PHOENIX AZ
85006-2754
US

IV. Provider business mailing address

601 N RITA LN #117
CHANDLER AZ
85226-6073
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-4516
  • Fax: 602-271-9909
Mailing address:
  • Phone: 480-656-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7296
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: